The FY 2026 ICD-10-CM update, effective October 1, 2025, includes 487 new codes, 38 revisions, and 28 deletions. Below is a summary of key changes that impact home health coding and their effect on billing:
New Code and Additions to the Code Set
- E11.A – Type 2 Diabetes Mellitus in Remission, allowing providers to more accurately report patients whose Type 2 Diabetes has regressed.
- The new code should be used only if provider documentation states the diabetes is in remission. If this is unclear, the provider must be queried for clarification.
- E11.A will carry a new “Excludes 1” instruction, meaning it cannot be reported alongside E11.9 (Type 2 Diabetes Mellitus without complications).
- 112 new codes for Non-Pressure Chronic Ulcers in the abdomen, chest, neck, face, groin, upper arm, forearm, and hand.
- 3 new codes for Malignant Inflammatory Neoplasm of the Breast
- 4 new codes for Thyroid Eye Disease (TED)
- Codes related to the Gulf War theater:
- T75.830- (Gulf War illness)
- Z77.31 (Contact with and suspected exposure to Gulf War theater)
- 8 new more specific codes for Multiple Sclerosis (MS) will replace G35. The new codes specifies MS type (relapsing-remitting, primary, secondary progressive), activity (active or non-active), or unspecified.
- New codes to identify the flank area location for lesions and wounds
- New codes for poisoning, adverse effects, and underdosing of Fluoroquinolone antibiotics.
- New, more specific codes to describe severity of intolerances and reactions to milk, dairy, eggs, and other foods.
- New codes under Z Code category for Genetic Susceptibility to certain Cancers and for Prophylactic Surgery related to Genetic Risk Factors.
- New diagnosis codes related to financial insecurity (part of CMS’s effort to improve data collection on Social Determinants of Health (SDoH)).
Revisions and Deletions to Watch Out For
28 deleted codes
Several deletions are replaced with more specific code expansions. For example:
- H01.8 (Other specified Inflammations of Eyelid) expands into nine new codes
- R10.2 (Pelvic and Perineal Pain) is now represented by six separate codes, including clarified terms like “lateral abdomen pain,” “lateral flank pain,” and “latus region pain”
38 revised code descriptors, such as:
- Codes that identify abscesses, cellulitis and other types of skin lesions and wounds were revised to now identify the back as a location.
- L02.212 updated from “cutaneous abscess of back [any part, except buttock]” to include the flank
- Updates in Chapter 19 that revise descriptions of wrist and hand fractures for improved specificity.
Tip: Review changes in every ICD-10 chapter except Chapter 8 (Diseases of the ear) and Chapter 22 (Codes for special purposes), where no changes were made
Billing Implications
- If any visit occurs on or after October 1, the entire claim must use the new codes.
- Claims with outdated codes for visits on or after October 1 will be rejected.
- Agencies can either update codes before submission or correct and resubmit after rejection.
- Proactive updating helps reduce reimbursement delays.
- If no visits occur on or after October 1, there is no need to update codes.
- Codes that become invalid as of October 1 must be updated before billing or corrected after rejection.
The new and changed codes in the FY 2026 code set have been assigned to PDGM groupers and comorbidity adjustment lists, if applicable, which could also impact HIPPS code assignment and payment on and after October 1.
Preparing for Changes
As the FY2026 ICD-10 updates take effect this October 1, it is important that your coding staff is updated on the changes and applies them accordingly. Make sure that all diagnosis codes are:
- Supported by provider documentation
- Accurate for both primary and secondary conditions
- Aligned with PDGM and home health billing requirements
Staying updated isn’t just about compliance—it ensures proper patient classification, improves data accuracy, and supports optimal reimbursement.
You can access official resources released by CMS here >
